Background: When a pediatrician has the right attitude and displays good clinical skills, it is often associated with a wide range of positive health outcomes among children. Objectives: The objective of this study is to determine caregivers' perception of the attitude and skill of pediatricians attending to children in tertiary hospitals. Materials and Methods: This study was carried out in the pediatric wards of three teaching hospitals from two Southeastern states of Nigeria, namely, the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu, Enugu State University Teaching Hospital (ESUTH) (both in Enugu State), and Federal Teaching Hospital, Abakaliki (FETA) in Ebonyi State. A structured, self-administered questionnaire was used to collect information from the caregivers of children who were admitted in the hospitals during the study period. Results: A total of 227 respondents were involved in this study. Of all the children, 94 (41.4%) were females and 133 (58.6%) were males. Over a third of the caregivers, i.e., 78 (34.4%), did not know the cadre of the doctor who examined them while the majority, i.e., 204 (89.9%), believed that the doctors who examined them were qualified and competent. Moreover, over half of the respondents admitted that the doctors who examined their wards were either very good [83 (36.6%)] or good [84 (37%)]. Conclusion: Pediatricians and doctors who care for children in tertiary hospitals in Southeastern Nigeria are perceived by caregivers to be skillful, caring, and friendly.

Keywords: Attitudes, caregivers, pediatricians, perception, skills

How to cite this article:Chinawa JM, Obu HA, Manyike PC, Obi IE, Chinawa AT. Caregivers' perception of the attitude and skill of pediatricians attending to children in tertiary hospitals. Ann Trop Med Public Health 2016;9:37-42

Consultations in which pediatricians display good interpersonal skills are often associated with a wide range of positive health outcomes among children. [1],[2],[3] Obtaining the perceptions of patients or caregivers in pediatric settings regarding the interpersonal skills demonstrated by their doctors could provide feedback on the doctors' behaviors that influence health outcomes. [4] The pediatrician's skills and character are vital aspects needed to dampen the tension, stress, and financial burden involved in taking care of sick children. Caring for a hospitalized child is a stressful event for parents and caregivers. Previous studies have found increased stress in families with children affected by different kinds of pathologies. [5] The parents have an important role in the promotion of their children's health as they are the primary agents involved in direct care, providing access to health services, and modeling attitudes and behaviors that influence the children's well-being. [6] Therefore, pediatricians, as a matter of necessity, should communicate efficiently and show a lot of empathy to these caregivers. Communication between the doctor and the patient is an interpersonal process and essential in relationship-centered care. However, in many studies, the doctors and the patients are studied as if living in separate worlds. [7] Effective communication skills have been shown to lead to better health outcomes following consultation between physicians and their patients. This includes more accurate identification of the patients' problems and a better understanding by the patients of their treatment plans. Patient satisfaction is also positively linked to their perception of the quality of communication skills displayed by their doctors. [8],[9]

The aim of this study was to determine the caregivers' perception of the attitude and skills of pediatricians attending to children in tertiary hospitals. It is hoped that the findings of this study will add to the body of knowledge on this challenging topic and may subsequently help to improve the management of children.

We are not aware of any study of this nature from this part of the world; hence, there was a need for a study with a view to provide information on this subject from our locale.

Materials and Methods

Study area

This study was carried out in the pediatric wards of three teaching hospitals in the Southeastern state of Nigeria, namely, the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu, Enugu State University Teaching Hospital (ESUTH) (both in Enugu State), and Federal Teaching Hospital, Abakaliki (FETA) in Ebonyi State.

Study population

An observational prospective study involving 227 children aged 6 months to 18 years and their caregivers seen at the pediatric wards of the three teaching hospitals between December 2012 and April 2013 was carried out using convenient sampling method . Selection was done regardless of the children's diagnosis.

Study procedure

A structured, self-administered questionnaire was used to collect information from the caregivers of the children who were admitted in the hospitals during the study period. In a few cases where the caregivers/children were illiterate, the questionnaire was administered to them by the investigators. The parents filled out a questionnaire rating the appropriateness of the various aspects of a physician's skills and attitude. Competence was defined in this study as the sufficiency of knowledge and skills that enable a physician to assess and manage his/her patient effectively."Qualified" was defined in this study as having the necessary skill, experience, or knowledge to do a particular job or activity.

The questionnaire used for this study was adopted from the guidelines for creating questionnaires for children by Eric Hultsch. [10] In obtaining consent, the parents/caregivers and the children were further informed of the voluntariness of their participation, the anonymity of the questionnaires, and that they could withdraw from the study at any point in time if they so desired without any consequences.

Ethical consideration and consent

Ethical clearance for the study was sought from the Research and Ethics Committee of the UNTH Ituku-Ozalla, Enugu. Informed consent was obtained from the parents/caregivers of the potential subjects before enrolling them for the study. Only those children and their caregivers who were admitted in the pediatric wards of the aforementioned hospitals and who gave verbal consent were included in this study. Children in a post- or preoperative state under medication or who were unconscious and parents/caregivers with psychiatric conditions or those who were not available during the doctors' visit were excluded from this study.

Case selection

The subjects who fulfilled the inclusion criteria were consecutively recruited for the study.

Data analysis

The data obtained were processed with the aid of a computer using statistical package (SPSS version 17, Chicago). Chi-square and Student's t-test were used for categorical and continuous variables, respectively, and the confidence interval was set at 95%.

Results

A total of 227 respondents were involved in this study. Of all the children, 94 (41.4%) were females and 133 (58.6%) were males. The predominant age group among the patients was 0-5 years. The caregivers interviewed were 227 in number, with 209 (92.1) being females and 18 (7.9) males. Their age predominantly ranged 30-39 years [n = 105 (46.3)] and in most of the cases the caregiver was the patient's mother, as seen in 190 (83.7%) cases [Table 1] and [Table 2].

Over a third of the caregivers, i.e., 78 (34.4%), did not know the cadre of doctors who examined them while the majority, i.e., 204 (89.9%), believed that the doctors who examined them were qualified and competent. Moreover, over half of the respondents admitted that the doctors who examined their wards were either very good [83 (36.6%)] or good [84 (37%)] [Table 5].

Table 5: Doctor's status and perception of the doctor's skill on examination of the patient

Majority of the caregivers, i.e., 208 (91.6%), noted that the doctor who examined them were friendly, with over half admitting that the doctors' attitude to their children were either excellent [77 (33.9%)] or very good [90 (39.6%)]. In addition, 175 (77.1%) of the caregivers also affirmed that the doctors who examined and cared for their children could be trusted and 113 (49.8%) stated that the doctors did not scare their children in the course of management [Table 6].

Table 6: Perception of the doctor's attitude and level of care toward the patient

There was some association between the duration of stay in the hospital and perception of the doctors' qualification, as the observed differences in the table were statistically significant (P ≤ 0.05). The suggestion, here, is that a short stay and a very long stay in the hospital tend to influence the perception of caregivers with regard to the doctors' competence [Table 7].

Table 7: Duration of the present admission with perception of the doctor as being qualified

[Table 8] suggests that the condition diagnosed in the course of admission shows no association with the perception of caregivers with regard to the doctors' competence. This is evident from the fact that none of the observed differences was statistically significant, thereby showing that the differences observed are purely due to chance.

Table 8: Condition diagnosed in the course of admission with the perception of doctor as qualified

This study throws light on how the pediatricians' skills/attitude to the children they look after are perceived by their caregivers. We noted with interest that majority of the caregivers were females and mainly mothers. Caregiving is a feminist issue because it overwhelmingly affects women, both as caregivers and as those likely to need care. [11] It is pertinent to also note that female caregivers are exposed to more stress-provoking experiences than men. [12],[13]

From this study, we deduced that over a third of the caregivers, i.e., 78 (34.4%), did not know the cadre of the doctors who examined their wards while the majority, i.e., 204 (89.9%), believed that the doctors who examined their wards were qualified and competent. The reason for this may be that the doctors failed to introduce themselves to the caregivers or patients during ward rounds and in the clinics. Communication between the pediatricians and caregivers is an important aspect in establishing a bond with the child. This communication includes the content of information exchanged and the relationship that existed in those moments. [13]

Crossley et al.[14] also noted that the length of acquaintance between the doctor and the patient and the workload in the clinic affect the interaction of the doctors with their patients and caregivers. This is also corroborated in our study where it was found that a short stay and a very long stay in the hospital tend to influence the perception of caregivers with regard to the doctors' competence. However, we found no association between the disease diagnosed in the course of admission and the perception of caregivers with regard to the doctors' competence.

The competence of the pediatrician cannot be overemphasized. Over half of the respondents admitted that the doctors who examined their wards were either very good or good. The reason why these pediatricians were seen as good may have been because they transmitted their skills through a caring, humane attitude rather than as technical knowledge. This was even corroborated by Lupton and Fenwick's study [15],[16] who noted that "chatting" and kindness were important in establishing a family-centered care in the hospital.

Watching pediatricians address children with gentleness also helps them to get closer; this increases confidence on the part of the caregiver. [17]

Furthermore, 77.1% of the caregivers affirmed that the doctors who examined and cared for their children were well-trusted and did not scare their children in the course of the management.

Trust is essential for effective communication and compliance with health care personnel. A number of studies have provided evidence that trust and mistrust affect the health care of patients. [18] Good communication was also identified as a vital aspect for establishing a relationship based on trust between the physicians and the family caregivers. Caregivers believe that good communication centered on the physician's ability to create an unhurried atmosphere despite a full and busy schedule is paramount in child recovery. [19] Some physician are also good communicators who took time to develop rapport with the caregivers, listened to their problems, educated them about medical conditions, and explained things to them in lay terms. All of these factors were reported to engender high levels of trust in the caregivers. [20] Another domain that influenced a relationship based on trust between the physicians and the caregivers was accessibility. [21] Physicians who were available when needed, spent appropriate time with their patients, and were willing to talk to the family members promoted the best relationships. This is similar to what was observed in the hospitals that were considered this study where the doctors who care for the children are in the hospitals on a 24-h basis. The quality of the physician and the trust that the caregivers had on them were assessed in this study with a questionnaire that seems to allow only fair to excellent responses. This may have contributed to the assertion that the pediatricians are skillful and well-trusted. Further studies using an elaborate Likert scale-type questionnaire to further develop the negative findings of the patients with regard to the doctors' skill and the trust they have on them will be worthwhile. However, this study highlights the finding of a positive perception that was proportionately more in this sample of patients.

Conclusion

The pediatricians and doctors who care for children in tertiary hospitals in Southeastern Nigeria are perceived by caregivers to be skillful, caring, and friendly.

Acknowledgements

All the authors contributed to the writing of this manuscript. JMC and HAO were involved in the conceptualization, formatting, and writing of this article. IEO and PM were involved in data collection and analysis.